Restless leg syndrome (RLS) can disrupt both your sleep and your dialysis sessions if you have chronic kidney disease (CKD). The uncomfortable and sometimes intense sensations in your legs can make it challenging to sit still during dialysis, prompting you to consider ending your session prematurely due to the discomfort. Many patients are unaware that these leg sensations constitute a medical condition that can be effectively treated.
Understanding RLS:
RLS is characterized by an uncomfortable sensation in the legs that compels you to move them. It typically occurs when you attempt to relax or fall asleep, often after prolonged periods of sitting or lying down, such as during dialysis, car rides, or plane trips. The sensations associated with RLS can vary from person to person, with some describing an itchy feeling, while others sense a crawling or “creepy” sensation. RLS can also be painful, manifesting as burning, aching, or prickling sensations.
Moving your legs provides relief from these uncomfortable sensations, leading you to engage in activities like walking, pacing, leg jiggling, or tossing and turning in bed to alleviate RLS symptoms. The symptoms are most pronounced at night, particularly during bedtime, disrupting your sleep patterns. This can result in difficulty falling asleep, staying asleep, and ultimately lead to insomnia. During the day, you may experience fatigue and irritability.
Causes of RLS:
RLS predominantly affects older individuals and can be associated with certain health conditions, including:
Diabetes can contribute to RLS by causing damage to tiny blood vessels and nerves, leading to impaired sensation in the extremities. People with diabetes are often advised to closely monitor their feet for signs of damage since nerve damage can render them less sensitive to injuries.
Previously, it was believed that iron deficiency or a lack of erythropoietin (EPO) could contribute to RLS. CKD often results in low iron levels and anemia, a condition characterized by a reduced number of red blood cells. Healthy kidneys produce EPO, a hormone that stimulates red blood cell production. As kidney function declines, EPO production decreases, leading to anemia, which is prevalent among end-stage renal disease patients requiring dialysis.
Treatment for anemia, involving medications or supplements, can also potentially benefit those with RLS. Animal studies have indicated that EPO may help stabilize or prevent nerve damage associated with diabetes. While the exact cause of RLS remains uncertain, treatment with EPO and iron supplements has shown promise in managing the condition.
Recent studies have suggested a potential link between RLS and low levels of parathyroid hormone (PTH). As individuals with kidney disease are at risk of bone-related issues, their doctors monitor PTH levels to prevent excessive elevation. Interestingly, patients reporting RLS often exhibited low PTH levels. Additionally, many of these patients were prescribed neurologic and psychiatric medications, which might potentially exacerbate or contribute to RLS. While the causal relationship between these medications, low PTH levels, and RLS remains unclear, these findings underscore the importance of avoiding excessive PTH suppression and carefully considering the use of neuropsychiatric drugs.
Treatment Options for RLS:
Medical treatment options for RLS include the use of EPO, iron supplements, adjustments to PTH treatment, changes to medications that may trigger or worsen RLS (such as certain antidepressants, cold and cough medications, or anti-seizure drugs), or prescription medications like clonazepam or benzodiazepines to alleviate symptoms.
Your doctor may also recommend self-administered home therapies to enhance sleep quality. These may include techniques like massage, warm baths, warm/cool compresses, relaxation exercises, changes to your sleep environment, and regular exercise.
